AANA Joins with the Coalition for Patients' Rights in Support of FTC
The AANA joined with other members of the Coalition for Patients’ Rights (CPR) to send a letter to the Federal Trade Commission (FTC) in support of their advocacy promoting access to cost-effective healthcare delivered by all qualified healthcare professionals within a competitive market. The letter is available on CPR’s website
. State nurse anesthetist associations who are state affiliates of CPR were signatories on the letter, in addition to the multidisciplinary national membership associations who are regular members of CPR.
AANA Health and Wellness is committed to helping all CRNAs and student registered nurse anesthetists live more healthy and productive lives. Essential to everyone’s well-being is moving in healthy ways
. Patti Bright, CRNA, AANA Walk/Run 2012 chair, has provided some training tips
to prepare for a 5K event so that you can walk or run to the finish line feeling strong and ready to tackle the rest of the day!
Surgical Fire Prevention Webinar
Want to learn more about surgical fire prevention? Join the Food and Drug Administration’s free surgical fire prevention webinar on June 12 from 1 – 2 p.m. ET. More information
Call for Comments from MHAUS
Join the Harvard Nurse Study
The Harvard School of Public Health and Brigham and Women’s Hospital are excited to announce that the Nurses' Health Study is growing. Started in 1976 and expanded in 1989, the information provided by its 238,000 dedicated nurse-participants has allowed NHS to produce key advances in literally hundreds of important topics–altering medical practice and changing national dietary guidelines. Nurses' Health Study 3 is now accepting nurses into their newest study. We encourage members and their colleagues to participate. Join
PCORI Seeks Applications to Fund $120 Million in Comparative Clinical Effectiveness Research
The Patient-Centered Outcomes Research Institute (PCORI) has released its first primary research funding announcements to support comparative clinical effectiveness research that will give patients and those who care for them the ability to make better-informed healthcare decisions. PCORI will award $120 million this year for innovative projects that effectively incorporate patients and stakeholders in research teams and address the areas of focus of PCORI's National Priorities for Research and Research Agenda, which was adopted by PCORI's Board of Governors at its public meeting in Denver, Colo., on May 21.
The four PCORI Funding Announcements (PFAs)
involve up to $96 million in funding and correspond to the first four areas of focus in PCORI's National Priorities for Research and Research Agenda:
Assessment of Prevention, Diagnosis, and Treatment Options - for projects that address critical decisions that patients, their caregivers and clinicians face with too little information
- Improving Healthcare Systems - for projects that address critical decisions that face health care systems, the patients and caregivers who rely on them, and the clinicians who work within them
- Communication and Dissemination - for projects that address critical elements in the communication and dissemination process among patients, their caregivers and clinicians
- Addressing Disparities - for projects that will inform the choice of strategies to eliminate disparities
All application materials can be downloaded from the Funding Opportunities
section of PCORI's website. A fifth PFA on Accelerating Patient-Centered and Methodological Research, involving up to $24 million in funding, will be issued during the summer.
AANA Foundation Friends for Life Deadline is June 15, 2012
Friends for Life help support the future of the nurse anesthesia profession through meaningful, lasting gifts. Contributions through Friends for Life help fund and sustain programs that further research and education in anesthesia. Members of Friends for Life receive a medallion at the Annual Meeting Opening Ceremonies, an engraved plaque in the AANA Park Ridge office, and an invitation to the Annual Awards and Recognition Dinner.
The minimum gift commitment to join Friends for Life is $25,000. Members may fulfill this commitment through a cash gift, but there are many other ways to meet the commitment through planned gifts. Some of the most popular planned gift options include:
- A gift (bequest) in the will for a specific amount or a percentage of the total estate
- Gift of personal property or real estate
- Including the Foundation as a beneficiary on a retirement plan or a whole life insurance policy
For more information, please contact Nat Carmichael at (847) 655-1175 or by email at firstname.lastname@example.org
The Friends for Life submission deadline for recognition at this year’s Annual Meeting in San Francisco, Calif. is June 15, 2012.
Recognition of COA Accreditation
The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) accreditation is recognized by the United States Department of Education (USDE) and the Council for Higher Education Accreditation (CHEA). In 2011, the CHEA Committee on Recognition found the COA in full compliance with all criteria and awarded 10 years, the maximum length of recognition.
Judith Eaton, president of CHEA, noted that recognition by CHEA affirms that COA’s standards and processes of accreditation are consistent with quality, improvement, and accountability expectations that CHEA has established. Presently, 48 states, the District of Columbia, Puerto Rico, and the Virgin Islands require nurse anesthetists to have graduated from an accredited nurse anesthesia educational program in order to practice. None of the states that require the national accrediting body be approved by the board of nursing have failed to approve the COA as the appropriate accrediting body. In addition, state boards of nursing periodically contact the COA to verify that educational programs of potential nurse anesthetist licensure applicants have been accredited by the COA. COA accreditation is also required for programs to receive federal funding through Title VIII, and for free-standing degree granting institutions to receive Title IV funding. Graduation from a COA-accredited program is also of significant importance because it is a prerequisite of eligibility to sit for the national certification examination.
AANA Website wins IMA Outstanding Achievement Award
The AANA website has received the 2012 Interactive Media Awards (IMA) Outstanding Achievement Award for Healthcare Websites. This award is the second highest honor bestowed by IMA. "Your website has excelled in all areas of our judging criteria and represents a very high standard of planning, execution and overall professionalism," IMA said in its congratulatory letter.
The AANA website was one of 168 submissions entered in the "healthcare" category. The site was judged on design, content, feature functionality, usability and standards compliance, and cross-browser compatibility.
Medicare Opens Medical Staffs to More CRNAs, APRNs, in Final Rule Governing Hospitals
Medical staff guidelines have been changed to accommodate CRNAs and other advanced practice registered nurses (APRNs) more thoroughly, and Medicare clarifies that it authorizes CRNAs and APRNs to order drugs and biologicals within their scope of practice and hospital policy, according to the preview of a final rule
issued by the Medicare agency May 10.
The final rule for reform of Medicare and Medicaid Hospital and Critical Access Hospital Conditions of Participation was the subject of an AANA regulatory comment letter, as well as a nurse organization coalition comment coordinated by the AANA. The final rule addresses many of the issues raised by AANA and APRN colleagues, and rejects the observation of medical group commenters that the policy “replaces doctors with nurses.”
Among other provisions:
- By broadening the concept of “medical staff” to explicitly allow hospitals to use other practitioners as candidates for the medical staff with privileges to practice in the hospital according to state law, the agency said it would “clearly permit hospitals to use other practitioners (e.g. APRNs, PAs, pharmacists) to perform all functions within their scope of practice.” It also authorizes that “all practitioners will function under the medical staff.” Most CRNAs practice under medical staff and the trend has been toward a greater number doing so.
- Also in agreement with AANA and APRN groups’ supportive recommendation, the agency adopted its proposal authorizing drugs and biologicals to be prepared and administered on the orders of practitioners other than physicians so long as hospital policy and state law allows, and for orders for drugs and biologicals to be documented and signed by practitioners other than physicians so long as hospital policy and state law allows.
- The agency acknowledged receiving AANA and APRNs’ comments favoring repeal of the Medicare physician supervision requirement and noted, “We appreciate the comments. However, this comment is outside the scope of the proposed rule and no changes will be made to this provision.” The agency also made note of a write-in campaign, referencing a medical group’s efforts to erect rhetorical straw men: “(T)here were some commenters that opposed the proposed provisions. Approximately 1,100 of the comments were part of a write-in campaign from anesthesiologists that supported what they described as CMS’ upholding of physician supervision requirements, but objected to what the letters described as an effort to replace physicians with nurses.”
- Verbal orders are subject to state requirements for timely authentication and no longer to CMS’s previous 48-hour requirement.
- The hospital is no longer required to maintain an infection control log, since other methods of infection reporting are already in use.
Drug Shortage Bills Now Await House, Senate Floor Action
Bills intending to address the issue of critical anesthesia drug shortages by requiring manufacturers to give greater advance notice of conditions that lead to shortages progressed through key House and Senate committees in May, and awaited full consideration by both chambers of Congress at press time. The AANA has been active on Capitol Hill to promote drug shortage relief legislation.
The House bill (HR 5651) includes provisions affecting certain drugs that the bill sponsors assert include drugs used by CRNAs in clinical practice, not all of which are anesthesia drugs. In a letter dated May 17, the AANA endorsed the Senate measure’s (S 3187) drug shortage language that applies to the manufacture of sterile injectable products or drugs used in emergency medical care or during surgery, stating, “We believe that this provision, by generating advance information about potential drug shortages, will help the marketplace to alleviate shortages of anesthesia drugs and other medications administered by CRNAs in surgical, interventional diagnostic, trauma stabilization, pain management, and labor and delivery settings.” In both cases, the drug shortage provisions are part of larger bills governing the Food and Drug Administration.
Is a Medicare CRNA Pain Care Rule Less than a Month Away?
A February letter from Health and Human Services Secretary Kathleen Sebelius said that the Medicare agency intended to publish a regulatory proposal creating a “consistent national policy” on Medicare direct reimbursement of CRNA pain care services as part of its 2013 physician fee schedule proposed rule. The rule usually comes out in late June, less than a month from today.
When the rule is released, AANA will review it and provide AANA members information to submit thoughtful comments to the Medicare agency themselves, and to urge colleagues, friends and family to do the same.
A year ago April, the Medicare Administrative Contractor (MAC) Noridian, which operates Medicare Part B in 18 prairie, mountain and far Northwest states, issued a policy without advance notice denying Medicare direct reimbursement to CRNAs providing medically necessary chronic pain care services within their scope. A second MAC, Wisconsin Physician Services (WPS), followed in the fall. Both MACs now only reimburse CRNA pain care services “incident to” a physician, meaning that the supervising physician bills for the CRNA in their employ.
If Medicare contractors can just stop directly reimbursing CRNAs for care within CRNA scope of practice, where will it end unless CRNAs speak out – as they have been with their members of Congress on Capitol Hill at Mid-Year Assembly and through CRNAdvocacy alerts online?
Stay tuned for more information, and for opportunities to protect your CRNA practice today and tomorrow.
Medicare Clarifies When Providers May Re-enroll Following Administrative Lapse
A provider whose Medicare enrollment lapses will not be treated like a criminal and banned from Medicare, and will be allowed to re-enroll, according to a final rule published in preview
by the Medicare agency on May 10.
The final rule also removes from regulations what the agency called its “outdated list of emergency equipment” required for ambulatory surgery centers (ASCs). Instead, under the new rule such lists must be developed by each ASC appropriate for the facility’s patient population and that items in the list must be immediately available.
The AANA in its comments underscored the importance of adherence to the emergency equipment requirement of the Malignant Hyperthermia Association, which the agency reflected in its commentary but declined to insert into the regulations.
Medicare Issues Hospital Inpatient Proposed Rule, Comments Due This Summer
The Medicare agency has proposed tying Medicare hospital payment incentives to achieving certain quality measures and has also proposed paying for reporting of other quality measures according to a notice of proposed rulemaking published May 11.
Of interest to CRNAs are the following proposals:
- Adding the Safe Surgery Checklist for the FY 2016 hospital quality reporting program;
- Adding Iatrogenic Pneumothorax with Venous Catheterization among the list of Hospital-Acquired Conditions (HACs) for FY 2013. Under this proposal, hospitals do not receive the higher payment for cases when an HAC is acquired during a hospitalization;
- Adding Healthcare-Associated Infections (HAIs), such as Central Line Associated Bloodstream Infection and Surgical Site Infection, for the FY 2015 and FY 2016 hospital quality reporting program;
- Adding Surgical Care Improvement Project (SCIP) Measures for the FY 2015 and FY 2016 hospital quality reporting program and for the FY 2015 and FY 2016 hospital value-based purchasing program.
The Medicare agency’s Hospital Inpatient Proposed Rule is under review by AANA, and subject to comment by June 25.
CRNAs Invited to Participate in Million Hearts™ Campaign
The U.S. Department of Health and Human Services (HHS) invites AANA members to participate in its Million Hearts Campaign, an initiative intended to reduce the incidence of heart attacks and heart disease with public education delivered through healthcare professionals like CRNAs. With the program aiming to prevent 1 million heart attacks and strokes over five years, CRNAs have a role to play by increasing awareness about heart disease prevention and empowering patients to take control of their heart health.
Ways in which CRNAs may contribute to Million Hearts™ include:
- Read patients' blood pressure out loud to increase patients awareness of their blood pressure and heart health
- Coach patients to develop heart-healthy habits such as regular exercise, a diet rich in fruits and vegetables, and stress reduction techniques
- Support smoke-free environments to reduce current and future cardiac risk
Million Hearts™ aims to provide additional focus on the ABCs (Aspirin for people at risk, Blood pressure control, Cholesterol management, Smoking cessation) for heart health. Individual CRNAs can support the Million Hearts™ Campaign by registering
at no charge.
Have You Received a Letter to Revalidate Your Medicare Enrollment?
The Centers for Medicare & Medicaid Services (CMS) continues to provide lists on their website of notices that have been mailed to providers whoneed to revalidate their Medicare enrollment. The latest update is for revalidations mailed through March 2012. If you receive such a letter, follow the letter’s instructions immediately, and provide it to your employer or billing agent as appropriate. Failure to comply risks reimbursement for your services.
FEC REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC
Gifts to political action committees are not tax deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use our best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. I am a US Citizen.
Decision-Making Processes Used by Nurses During Intravenous Drug Preparation and Administration
Mistakes involving intravenous drugs represent a significant problem in clinical settings, accounting for approximately a third of all drug errors. Building on past research, which primarily has focused on observing nurses and documenting their missteps, a U.K. team of investigators not only watched nurses prepare and administer IV drugs but also interviewed them about the decision-making process. The study followed 20 nursing professionals for one week. A key issue emerging from the research was that, believing themselves adequately familiar with a patient, there was a tendency by nurses not to check patient identity before administering IV drugs. Interruptions, as well the entrenchment of routinized behavior, also contributed to IV drug errors. The results, they concluded, point to a need to consider new and effective strategies, based on behavioral theories, for educating nurses; to give staff a hand in updating policies and procedures; and to formally evaluate personnel during IV preparation and administration.
From "Decision-Making Processes Used by Nurses During Intravenous Drug Preparation and Administration"
Journal of Advanced Nursing (06/12) Vol. 68, No. 6, P. 1302 Dougherty, Lisa; Sque, Magi; Crouch, Rob
Pain Management in Neonates: A Survey of Nurses and Doctors
Concerned that pain is often unrecognized and under-treated in neonates, researchers sought to evaluate the knowledge and reported practice of nurses and doctors on procedural pain assessment and management in neonatal intensive care units (NICUs). Existing guidelines recommend the administration of analgesia and comfort measures, but they may be impacted by inter-professional differences in guideline implementation. All nurses and doctors surveyed were working in seven NICUs in one area of the United Kingdom from January to August 2007. The respondents were found to be knowledgeable and agreed that neonates feel pain and need analgesia. Chest drain insertion was regarded as the most painful procedure, while heel-pricks were seen as the least painful. According to the data, analgesia and comfort measures were not usually administered for most procedures, but nurses were more likely than doctors to report adhering to guidelines advocating administration of analgesia and comfort measures. Differences between current and optimal practice were acknowledged and attributed to such things as inadequate training and insufficient use of accepted pain assessment instruments. The researchers concluded that clinicians were knowledgeable about neonatal pain but had gaps between knowledge and practice. This could be addressed with the use of guidelines that cite evidence for the efficacy of validated pain assessment instruments.
From "Pain Management in Neonates: a Survey of Nurses and Doctors"
Journal of Advanced Nursing (06/12) Vol. 68, No. 6, P. 1288 Akuma, Akuma O.; Jordan, Sue
U.S. Anesthetics Market to be Worth $7B by 2015
A new report from MedReps indicates that the U.S. market for both generalized and localized anesthesia drugs will be rise by about 4 percent to be worth $7 billion by 2015. Manufacturers of ketamine could see the highest profits in this category, an Anesthesia Drug Market study found. At present, the only branded version of the drug available is Ketalar, distributed by JHP Pharmaceuticals, and it is expected to maintain high growth in the next five years.
From "U.S. Anesthetics Market to be Worth $7B by 2015"
Becker's ASC Review (05/12) Tawoda, Taryn
U.S. States Urge Return of Drug Used in Executions
The Justice Department has been asked by 15 states for help in obtaining the anesthetic used in executions, which a federal judge in March ruled as being illegally imported. The dispute is unfolding in a lawsuit over whether the Food and Drug Administration (FDA) is authorized to allow imports of sodium thiopental when the drug is not approved for use in the country. The 15 state attorneys general say that if the March decision remains in place, states will be forced to seek alternative means for lethal injection as the only U.S. source of sodium thiopental ceased production in 2011. After the March ruling, the FDA asked states with supplies of foreign-made sodium thiopental to turn over the drug in April.
From "U.S. States Urge Return of Drug Used in Executions" The Republic (IN) (05/21/12) Ingram, DavidReturn to Headlines
Genes Tied to Anesethesia Resistance
In New Zealand, a study examining the genes of those who have reported awareness during anesthesia is being conducted by the University of Auckland, Waikato Hospital, and the Royal Children's Hospital in Melbourne. The research hopes to recruit about 100 individuals who have reported such awareness to test the hypothesis that resistance to anesthesia could be tied to the way that genes interact with the drugs. This hypothesis has been non-scientifically supported by reports of a family history of awareness by some patients.
From "Genes Tied to Anesthesia Resistance" Newsmax Health (05/14/12)
Early Epidural No Advantage for Blunt Thoracic Injury
A new study led by Julin Tang, MD—clinical professor of anesthesia and critical care medicine at the University of California, San Francisco School of Medicine—questions the benefit of thoracic epidural anesthesia (TEA) in cases of blunt chest injury with three or more rib fractures. It had been thought that early epidural analgesia would reduce the number of pulmonary complications for patients with blunt chest injury and would abbreviate time in the intensive care unit and the hospital. The study reviewed the medical records of 187 non-intubated patients with blunt thoracic injury who were treated at San Francisco General Hospital during a five-year span, where 18 percent of the cases used early epidural analgesia. It was found that early TEA did not reduce the incidence of pulmonary complications compared with patient-controlled analgesia with opioids and that those receiving an early epidural had longer stays in both the ICU and hospital. Tang is in the process of designing a prospective study to compare early epidural analgesia with opioid analgesia in patients with blunt thoracic injury, which he has redesigned since seeing the results of the initial study.
From "Early Epidurals No Advantage for Blunt Thoracic Injury" Anesthesiology News (05/01/12) Vol. 38, No. 5 O'Rourke, KateReturn to Headlines
ACTs Shortened With Less Protamine for Heparin Reversal
New research suggests that using lower dosage regimens of protamine to reverse heparin after cardiopulmonary bypass are effective, researchers say. A new study shows that, compared with normal doses of protamine, lower doses appeared to have shorter clotting times. Researchers reviewed the charts of 68 patients who underwent cardiac bypass surgery at University of Florida in Gainesville between July 2009 and July 2010. Half of the patients received the normal dose of 1 to 1.3 mg of protamine per 100 units of heparin, while the other half received 0.5 to 0.7 mg of protamine per 100 units of heparin. The low-dose patients had lower post-protamine activated clotting time values, even after controlling for variables such as age, sex, and weight. There were no significant differences between the two groups in intraoperative and postoperative requirements for packed red blood cells, fresh frozen plasma, and platelets, or for length of stay in the intensive-care unit or for 48-hour chest tube output. Although the study was small, it did suggest that a lower dose of protamine is at least as effective and safe as a normal dose for heparin reversal. The protamine dose used to calculate the study's ratio only accounted for pre-bypass heparin.
From "ACTs Shortened With Less Protamine for Heparin Reversal" Pharmacy Practice News (05/12) Vol. 39 Wild, DavidReturn to Headlines
Combination Therapy Solves Postoperative Nausea and Vomiting (PONV) Dilemma
Research recently published in Anesthesia & Analgesia indicates that an acustimulation disposable wrist device has clinical effects in reducing postoperative nausea and vomiting (PONV). The study looked at the antiemetic prophylaxis of the product when used in combination with antiemetic treatments such as 5-HT3 antagonist, ondansetron, and dexamethasone, compared to the drug combination alone in patients undergoing major laparoscopic surgery procedures. Studies show that nearly one third of surgical patients are affected by PONV, despite widespread use of various antiemetic prophylactic treatments. Lixing Lao, director of the Center of Integrative Medicine at the University Of Maryland School of Medicine, explained in a 2009 Science Daily article that stimulating the acupoint P6 with a device helps to prevent nausea by signaling the brain to release neurotransmitters that block the chemicals that can cause PONV.
From "Combination Therapy Solves Postoperative Nausea and Vomiting (PONV) Dilemma" Newswise (05/08/12)Return to Headlines
The Environmental Impact of Anesthetic Gases
In a recent paper published in a special issue of Anesthesia & Analgesia, researchers performed life-cycle assessments of the major anesthetic gases nitrous oxide, desflurane, isoflurane, and sevoflurane as well as the liquid anesthetic propofol. The investigation was prompted by curiosity about how the healthcare industry, which accounts for 8 percent of U.S. greenhouse gas emissions, affects health through direct and indirect changes it makes to the environment. The paper showed that the combined environmental impact of production, transportation, waste disposal, and other life-cycle events was insignificant compared to the impact of the anesthetic gases alone. Desflurane by itself, for example, has a global warming potential more than 2,500 times that of carbon dioxide, according to one of the authors—Yale University assistant professor Matthew Eckelman. The gases have quite an environmental impact, as only small amounts are metabolized by the body while the rest are vented out of the hospital roof; and they also require a carrier gas—often nitrous oxide—that also gives off emissions. The research team recommended that desflurane be avoided if possible; that oxygen be used instead of nitrous oxide as a carrier gas; that the fresh gas flow rates be minimized, and that an IV anesthetic alternative be used in all applicable cases, as the environmental impacts of propofol were found to be negligible in comparison to the inhaled anesthetics.
From "The Environmental Impact of Anesthetic Gases" Northeastern University News (05/22/12) Herring, AngelaReturn to Headlines
Medical College Researcher to Study the Effect of Anesthesia on Brain Networks
The National Institutes of Health's National Institute of General Medical Sciences has awarded a $1.2 million grant to the Medical College of Wisconsin, for the study of the neural mechanisms involved in general anesthetics. Dr. Anthony G. Hudetz,, professor of anesthesiology, physiology, and biophysics, is the principal investigator. Although anesthetics suppress memory and consciousness, researchers do not fully understand how these effects are achieved. Hudetz's hypothesis is that general anesthetics disrupt the network integration of nerve cells in the brain. This research will add to existing knowledge of how anesthetics affect consciousness and could contribute to the development of safer anesthetics and improved monitoring methods.
From "Medical College Researcher to Study the Effect of Anesthesia on Brain Networks" Wauwatosa Now (05/22/12) Mack, MaureenReturn to Headlines
NIH Selects 11 Centers of Excellence in Pain Education
The National Institutes of Health Pain Consortium has selected 11 health professional schools as designated Centers of Excellence in Pain Education (CoEPEs). These CoEPEs will serve as hubs for the development, evaluation, and distribution of pain management curriculum resources for nursing, dental, medical, and pharmacy schools. The aim is to improve how healthcare professionals are taught about pain and its treatment. Awardees include Southern Illinois University, the University of Rochester, and the University of New Mexico. Chronic pain currently affects approximately 100 million Americans, costing up to $635 billion in medical treatment and lost productivity. The curricula developed by the CoEPEs will feature multiple case-based scenarios, including those taught through video or electronic formats. The curricula will teach about the pathophysiology and pharmacology of pain and its treatment, the latest research in complementary and integrative pain management, factors that contribute to both under- and over-prescribing of pain medications, and how pain manifests itself differently by gender, age, and in diverse populations.
From "NIH Selects 11 Centers of Excellence in Pain Education" NIH News (05/21/12)